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Distributed Network for Ambulatory Research in Therapeutics

Topic Abstract

The Distributed Ambulatory Research in Therapeutics Network (DARTNet) is a federated network of electronic health databases created in 2008. Its purpose is to facilitate quality improvement of primary healthcare and to efficiently compile clinically-enriched data for comparative effectiveness research. A federated network such as DARTNet links geographically and organizationally separate databases to allow a single query to pull information from multiple databases while maintaining the privacy and confidentiality of each database.

The DARTNet federated network begins within each member organization, where a database assembles patient-level information (such as vital signs, social history, family history, and physical examination findings) from electronic health records, pharmacy utilization databases, and billing systems. This aggregated clinical information is then standardized, de-identified, and linked securely through the Web to similar databases in other DARTNet member organizations. Once linked, a database query can be sent to all federated databases at once.

In addition to facilitating queries among the federated databases, the DARTNet system can prompt clinicians to obtain specific information during a patient encounter. This capability allows research teams to collect additional data beyond what would normally be recorded during clinical care. Thus, DARTNet research projects can include observational research and practical clinical trials. DARTNet is also designed to help support a learning community, where health care providers from DARTNet member organizations can learn from the best practices of high-performing member practices, which are identified by comparing quality indicators of clinical care provided across the network.

DARTNet will also advance observational comparative effectiveness research (OCER) methods, which have traditionally depended on data sets created for other purposes, such as administrative data sets created to process insurance claims. DARTNet enhances these methods by providing a way to account for important clinical information that is missing from claims databases.

DARTNet’s capabilities were demonstrated by a retrospective cohort study that evaluated patterns of use, comparative effectiveness, and safety of oral diabetes medications for adults with type 2 diabetes. The study was conducted in two phases. Phase 1 used a commercially available, integrated medical claims database to examine the comparative effectiveness and safety of oral diabetes medications. Phase 2 used DARTNet data for the same purpose, and showed that DARTNet can identify comparable panels of diabetic patients receiving various combinations of oral diabetes medications similar to the traditional OCER study completed in phase 1. It also showed that DARTNet can collect clinically-relevant data such as body weight, height, self-reported alcohol intake, and self-reported hypoglycemic events, which were absent in the claims database. The initial results from DARTNet data analyses indicate that the comparative effectiveness and safety of oral hypoglycemics is similar to that observed in the Phase 1 study.

The next steps for DARTNet include expanding its technical capabilities to complete the analyses of phase 2 as well as scale up the size and diversity of DARTNet clinical entities and population. Further, DARTNet will refine the final organizational structure of the network, define the selection process for research and quality improvement projects, and develop DARTNet’s capacity as a learning community. By successfully combining the concepts of point-of-care data collection with secondary analysis of electronic medical record data from large populations of patients, DARTNet holds great potential for becoming a valuable tool for comparative effectiveness research and improving the quality of care provided by its members.